Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

Sarcoidosis 1321

General Measures

■Assess extent & severity of organ involvement, whether disease stable

or likely to progress & need for treatment

specific therapy

Indications

■Controversial: many patients undergo remission without specific

therapy

■Mild & focal disease (eg, skin lesions, anterior uveitis, cough) may

respond to topical steroid therapy

■Systemic disease:

➣Absolute indications: cardiac or neurosarcoid, eye disease not

responding to topical therapy, hypercalcemia

➣No treatment necessary: asymptomatic stage 0, I or II disease

with no objective signs of pulmonary impairment

➣Less well-defined indications: severe symptoms in any organ,

progression of symptoms or worsening pulmonary function

Treatment Options for Systemic Disease

■Treatment of choice: oral prednisone

➣Most pts require minimal effective dose steroid therapy for sev-

eral mo, then slow taper to maintenance dose over 6 mo

➣After clinical response, alternate-day therapy is an option to

decrease side effects

➣Total length of therapy approx 12 mo

➣Some pts require long-term therapy or increased doses due to

relapse

■Second-line therapy: methotrexate, azathioprine, cyclophospha-

mide, cyclosporine & chloroquine (specialty referral recommended)

➣Used when oral steroid Rx contraindicated ineffective or as a

steroid-sparing measure

Side Effects

■Prednisone: weight gain, osteoporosis, hyperglycemia, cushingoid

syndrome, cataracts, avascular necrosis of the hip, peptic ulcer dis-

ease, skin fragility, myopathy

■Cyclophosphamide (bladder toxicity) & azathioprine; hematologic,

carcinogenic, teratogenic

■Methotrexate: liver & lung toxicity, mucositis, teratogenic

■Chloroquine: retinal toxicity